Provider Demographics
NPI:1770386740
Name:AVANTE LASER & MEDISPA
Entity type:Organization
Organization Name:AVANTE LASER & MEDISPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING DIRECTOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-475-4705
Mailing Address - Street 1:8708 TECHNOLOGY FOREST PL STE 125
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1182
Mailing Address - Country:US
Mailing Address - Phone:281-475-4705
Mailing Address - Fax:
Practice Address - Street 1:8708 TECHNOLOGY FOREST PL STE 125
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1182
Practice Address - Country:US
Practice Address - Phone:281-475-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center